Video games, which have been linked to childhood obesity, aggression and poor school performance, are currently being used in the training of surgical residents. Most of the reported effects of video games in the media appear to center upon the alleged negative consequences: video game addiction, increased aggressiveness and various medical and psychosocial effects. However, there has been a significant increase in the number of references demonstrating the positive benefits of video games. Research dating back to the early 1980s has consistently shown playing computer games produces reductions in reaction times and increased player self-esteem.
It is becoming increasingly evident video games have great positive potential in addition to their entertainment value. There has been considerable success when games are designed to address a specific problem or to teach a certain skill. It has been successfully demonstrated playing action video games enhances visuospatial attention and spatial resolution in a positive manner, and gamers have significantly better hand-eye coordination than non-gamers.
A 2009 study published in the World Journal of Surgery demonstrated after five weeks of training with a first-person shooter for at least half an hour a day for five days a week, medical students scored significantly better on a laparoscopic simulator than a matched group which had not been playing video games. Simulators designed for surgical residents have consistently proven their usefulness in laparoscopy, however, they are expensive and not widely available. Video games on the other hand are inexpensive and have been proven effective as an academic aid for learning at multiple age levels. Thus there is tremendous potential to supplement surgical simulators with video games for the purpose of training surgical residents.
Recent studies have demonstrated the video game “Underground,” a game specifically aimed at training basic laparoscopic skills, could effectively be used for pre-operative preparation in an experimental setting. In “Underground,” players use two Wii Remote controllers in custom-made laparoscopic tool shells to play a game based on movements made during laparoscopic surgery. In contrast to simulators, the game does not contain actual medical content, but comprises a story-driven mode, based on a fictional world where the player has to help small robots to escape from a mine. To aid the robots in their escape, the player controls two large robotic arms and demolishes and rebuilds the environment of the mine. The concept of a mine was chosen because laparoscopic surgeons operate in a relatively dark area and have to deconstruct objects (adhesiolysis, ligation of mesentery and resections) before they can begin to rebuild (anastomoses and hernia repairs). During the game, players learn to handle analogous versions of laparoscopic equipment under familiar circumstances such as the lack of depth perception and inverse movements. The player is rewarded for handling the equipment carefully and minimizing collateral damage.
There appears to be a positive correlation between playing video games and basic laparoscopic skills. However, the lack of sufficient existing evidence makes it difficult to establish the positive effects of gaming in the development of surgical skills. There is no validated scale or questionnaire to assess game experience and researchers fail to use a uniform method for the assessment of laparoscopic skills. The vast majority of trials have used small research groups and observed totally different parameters. Further research must be performed on this subject using more consistent standardized assessment mechanisms with larger sample sizes. Hopefully the introduction of certain video games similar to “Underground” will help to combat the limitations of current research.